Compartment syndrome in all extremities is an orthopedic emergency. The hand muscles are covered and divided by groups into compartments by a well defined, unyielding envelope called the deep fascia. view

An amputation is the severing of a body part. Amputations are classified as partial and complete and if the amputation was a clean cut, a crushing amputation or an avulsion amputation where the amputated limb is pulled right off of the body. view

The most frequent swelling or masses found at the hand and wrist level are ganglion cysts. view

HAND DISLOCATIONS

Pathology

Dislocations of the hand are injuries frequently associated with high energy trauma like a fall from a height, a motor vehicle collision or a sporting event. A dislocation is the separation of two bones at the level of the joint with disruption of the ligaments that normally attach and keep them together. The extent of the soft tissue disruption can vary. The proximal interphalangeal joint (PIPJ)is the most important joint in the fingers and also the most frequently affected joint. The spectrum of PIP injuries ranges from the simple jammed finger, to the most severe and disabling irreducible fracture dislocation where the joint surface is broken along with disruption of the ligaments. A dislocation can be an isolated injury or can be associated with fractures that frequently extend to the joint which increases the risk of post-traumatic arthritis. The dislocations will present as either Closed in which the skin is intact, or Open which involve wounds that communicate with the fracture. Open injuries carry a risk of infection and therefore require immediate treatment the day of injury. Dislocations may return spontaneously (auto-reduction) or require a manipulation to reduce the joint to the original position. Some closed injuries that are manipulated remain dislocated in spite of the efforts of a health provider to put it back in place (irreducible dislocation) which may be due to soft tissue interposition in the joint or global tendon disruption.

Treatment

Closed dislocations that can be reduced, can be treated with a brief period of rest, ice, compression, hand elevation, early protected motion and protective splint (blocking splint) that is placed in an angle that limits motion beyond a certain point initially so a dislocation does not recur during the healing stage. Another treatment option called buddy splinting is when the injured digit is bound to the adjacent digit to serve as a dynamic splint, to protect from further trauma while permitting motion that prevents stiffness.

Dislocations that are open, irreducible, associated with instability, subluxation, recurrent dislocation or associated with a fracture that renders the joint unstable requires surgical intervention. Surgical options may consist of attempting a closed manipulation and percutaneous pinning, open release of offending reduction restraints and ligament repairs as indicated, and finally open reduction with internal fixation of the fracture when present. Open dislocations and irreducible dislocations need emergent treatment due to the increased risk of infection and vascular compromise. Most dislocations can be followed with a HEP focused on early protected range of motion. Some patient with more complex dislocations or associated injuries will require of a formal hand therapy program according to the associated injuries.